Blepharoplasty (Eyelid Lift)
Aesthetically, as well as metaphorically, the eyes are the windows to the soul; we communicate so much of our thoughts and emotions with facial gestures centred around our eyes. With the passage of time, the eyelids, the cheek and the brow all change. Puffy eyes, lax skin, crow’s feet wrinkles, and tired and droopy lids may alter our expression radically. Blepharoplasty alone or as part of more extensive facial rejuvenation surgery addresses many of these problems, restoring harmony and giving a refreshed, alert look.
Blepharoplasty is one of Dr Farhadieh’s areas of special interest. He has co-authored a plastic surgery textbook chapter on this topic: An introduction to lower lid rejuvenation, in Plastic and Reconstructive Surgery: Approaches and Techniques. The procedure is divided into upper lid and lower lid blepharoplasties.
In principle, the mid-cheek soft tissues form the foundation support for the lower eyelids. As the mid-cheek descends with ageing, it has varying effects on the lower lid appearance and topography, depending on the individual facial structure. The upper lids, by contrast, can be thought of as being suspended from the brows (forehead). A descent of the brow by the ageing process may similarly exaggerate or affect the appearance of the upper eyelids.
The aim of blepharoplasty is to remove the excess skin, reduce all herniated (protruding underlying fat causing puffiness of the eyelids) tissues to their rightful place and tighten the skin and appearance of the eyelids. Addressing the brow or the mid-cheek may be vital in achieving a long-lasting, reliable outcome.
During your initial consultation Dr Farhadieh will ask you what facets of your facial aesthetics you wish to address. Collection of a detailed record of any functional ophthalmological history, including ‘dry eyes’, is vital to aesthetic eye surgery. The eyes and eyelids need to be assessed in the context of the remainder of your face. Smokers will be advised to cease smoking for 3–6 weeks prior to surgery and to abstain for at least 3–6 weeks afterwards.
Your general medical history, including a detailed past medical history, current medications, allergies, smoking history and family histories are recorded. Blood-thinning medications, including aspirin, warfarin and clopidogrel, are considered significant risk factors for surgical bleeding and you should inform your surgeon if you are taking any of these or supplementary health vitamins which may interfere with wound healing or blood functions. You need to stop taking them around 2 weeks prior to surgery. Some medical problems such as hypertension (high blood pressure), thyroid disease or diabetes may affect surgery adversely and need to be considered.
The surgery itself takes between 45 minutes and 2 hours. In the upper lid the incision is hidden in the skin folds. The surgery may be performed under sedation or general anaesthetic with local anaesthetic. After incision, a small amount of redundant skin is removed. Usually small amounts of protruding fat are removed with tightening of the underlying eyelid structures. Depending on the problem and whether a mid-cheek lift is being performed, the lower lid incision may be hidden just inside the eyelid, outside in a skin crease or a combination of both. Similarly for the upper lids often a small amount of skin is removed, the eyelid structures are tightened and the eyelid is resuspended from the orbital rim.
After the surgery you will be taken to the recovery area and then to your room, where your eyes will be covered with cold compresses to reduce the swelling. Your eyesight will be blurry during the first evening. If you are discharged home as part of day surgery, you should make sure that someone can drive you home and if possible stay with you the first night. Cooling the eyelids with ice gels and elevating the head on a couple of pillows reduces the swelling. The first nights should be spent resting quietly. You will be seen again 5–7 days after the operation for a check and for removal of the sutures.
Although complications with blepharoplasty are uncommon, Dr Farhadieh will discuss these with you during your consultation at length. Facial harmony and assessment of the overall facial aesthetics is an integral part of considering facial rejuvenation, in order to avoid a piecemeal and artificial look. Your relationship with your surgeon is an integral aspect of your care. It is a journey that patients should take with good knowledge and consideration. We are dedicated to being there for every step of the journey with you.
‘Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.’
Frequently Asked Questions
Will I need a General Anaesthetic?
Yes this is the best option, this will be performed in an appropriate accredited facility under general anaesthesia. Depending on the individual and extent of surgery overnight admission might be considered.
How long will the recovery take?
There will be swelling and bruising associated with this operation and most patients wear a pair of sunglasses for the first 10–14 days. The majority of people return to work after 2 weeks. Sensation at and surrounding the site of incision may be altered for a few weeks, but this rarely persists longer than a few months.
Is postoperative asymmetry common or a risk?
We all have intrinsic asymmetry in our faces and bodies. In appropriately trained hands there should not be any noticeable asymmetry resulting from surgery.
What is revision surgery?
Secondary surgery to the eyelids to address natural ageing after primary eyelids surgery or correction of any previous asymmetries resulting from surgery is called revision surgery. Because of previous procedures, revision surgery often involves more nuanced techniques to achieve an optimal final outcome.
What will my follow up include?
Dr Farhadieh believes that the relationship between doctor and patient is sacred and privileged. Our practice is based on compassion, honesty, transparency and, above all, patient welfare. We pride ourselves on making sure that you feel supported at all times. We will be available during all stages of your journey and will schedule short-, medium- and long-term follow-up appointments as part of our overall practice.